Renal and urology Flashcards
How might babies with UTIs present
Fever
Lethargy
Irritability
Vomiting
Poor feeding
Urinary frequency
How might infants and children present with UTIs
Fever
Suprapubic abdominal pain
Vomiting
Dysuria
Urinary frequency
Incontinence
How might a patient with acute pyelonephritis present
Temperature > 38
Loin pain and tenderness
What investigations are needed for UTIs
Urine dip (clean catch sample)
If recurrent
- Ultrasound (all under 6 months within 6 weeks)
- DMSA (scan 4-6 months after illness, look for damage)
- Micturition cystourethrogram (look for vesico-ureteric reflux)
What is the management for babies under 3 months with a UTI
Immediate IV antibiotics (ceftriaxone)
Full septic screen
Consider lumbar puncture
(Applies to all under 3 months with a fever, regardless of suspected cause)
What is the management of UTIs in children over 3 months
Consider antibiotics (trimethoprim, nitrofurantoin, cefalexin, amoxicillin)
What is vulvovaginitis
Inflammation and irritation of vulva and vagina
Common in girls 3-10 (less common after puberty, as oestrogen protects skin and mucosa)
What are the exacerbating factors for vulvovaginitis
Wet nappies
Use of soap in the area
Tight clothing that traps moisture
Poor toilet hygiene
Constipation
Threadworms
Pressure on area
Heavily chlorinated pools
How might a child with vulvovaginitis present
Soreness
Itching
Erythema around labia
Vaginal discharge
Dysuria
Constipation
What are the investigations for vulvovaginitis
Urine dip (leukocytes, but no nitrates)
What is the management for vulvovaginitis
Usually only need to avoid exacerbating factors
Oestrogen cream for severe cases
What is nephrotic syndrome
Basement membrane in glomerulus becomes highly permeable to protein
Most common in 2-5s
Classic triad: hypoalbuminaemia, proteinuria, oedema
How might a patient with nephrotic syndrome present
Frothy urine
Generalised oedema
Pallor
Deranged lipid profile
Hypertension
Hypercoagulability
What are the causes of nephrotic syndrome in children
Minimal change disease (treated with prednisolone)
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
Diabetes
Infection
What is the management for nephrotic syndrome
High dose steroids (prednisolone, for 4 weeks, wean over 8 weeks)
Low salt diet
Diuretics
Consider albumin infusion
Consider prophylactic antibiotics
What are the complications of nephrotic syndrome
Hypovolaemia
Thrombosis
Infection
Acute or chronic renal failure
Relapse
What is nephritis
Inflammation within nephrons of kidney
Classic triad of: reduced kidney function, haematuria, proteinuria
What are the common causes of nephritis in children
Post-streptococcal glomerulonephritis (1-3 weeks after group B strep infection, get AKI, supportive management, consider antihypertensives and diuretics)
IgA nephropathy (in teens, treat with immunosuppressants (steroids slow progression of disease))
What is haemolytic uraemic syndrome
Thrombosis within small blood vessels throughout body
Triggered by shiga toxin (E coli 0157)
Classic triad of: haemolytic anaemia, AKI, thrombocytopenia
A medical emergency
How might a patient with haemolytic uraemic syndrome present
Around 5 days after onset of diarrhoea
Reduced urine output
Haematuria or dark brown urine
Abdominal pain
Lethargy
Irritability
Confusion
Oedema
Hypertension
Bruising
What is the management for haemolytic uraemic syndrome
Supportive care
Consider urgent referral for dialysis
Blood transfusion if needed
What is enuresis
Involuntary urination
Most children out of daytime urination by age 2
Most children out of night time urination by age 3-4
What is primary nocturnal enuresis
Child has never managed to stay dry consistently at night
Usually part of normal development
What are the causes of primary nocturnal enuresis
Normal development
Overactive bladder
Fluid intake before bed
Failure to wake up due to deep sleep
Psychological distress
Secondary causes (chronic constipation, UTIs, learning disability, cerebral palsy)
What is the management for primary nocturnal enuresis
Reassure parents that it will likely resolve by age 5
Less fluid in evening
Encouragement and positive reinforcement
Treat underlying cause
Enuresis alarm
Pharmacological treatment
What is secondary enuresis
Wetting bed when previously dry for 6 months
Possible causes: UTI, constipation, T1DM, new psychosocial problem, maltreatment, consider abuse and safeguarding
Treat underlying cause
What is diurnal enuresis
Dry at night, but occasionally incontinent during the day
Mostly in girls
Causes: urge incontinence, stress incontinence, recurrent UTIs, psychosocial problems, constipation
What are the pharmacological managements for enuresis
Desmopressin (ADH analogue, reduces volume of urine produced)
Oxybutynin (anticholinergic, reduces contractility of bladder)
Imipramine (tricyclic antidepressant, relaxes bladder and lightens sleep)
What is autosomal recessive polycystic kidney disease
Presents in neonates
Usually picked up on antenatal scanning
Cystic enlargement of renal collecting ducts
Oligohydramnios and pulmonary hypoplasia
Congenital liver fibrosis
May need dialysis in first few days of life
May have end stage renal failure before starting school
Poor prognosis (1/3 die as neonates)
What is a Wilms tumour
Tumour of the kidneys in children
Usually affects under 5s
How might a patient with a Wilms tumour present
Mass in abdomen
Abdominal pain
Haematuria
Lethargy
Fever
Hypertension
Weight loss
What are the investigations for Wilms tumour
Ultrasound abdomen
CT/MRI for staging
Biopsy
What is the management for a Wilms tumour
Surgical excision (of tumour and kidney)
Adjuvant chemotherapy and radiotherapy
Good prognosis with early treatment
What is a posterior urethral valve
Tissue at proximal end of urethra, causes obstruction of urine flow
In newborn males
Can develop hydronephrosis
Increased risk of UTIs
How might mild cases of posterior urethral valve present
Difficulty urinating
Weak urine stream
Chronic urinary retention
Palpable bladder
Recurrent UTIs
Impaired kidney function
How might severe cases of posterior urethral valve present
Bilateral hydronephrosis
Oligohydramnios (get underdeveloped fetal lungs, respiratory failure shortly after birth)
What are the investigations for posterior urethral valve
Picked up on antenatal ultrasound
If presenting at birth: abdominal ultrasound, micturition cystourethrogram, cystoscopy
What is the management for posterior urethral valve
Mild: monitor, temporary urinary catheter
Definitive management: ablation or removal (via cystoscopy)
What are the risk factors for undescended testis
Family history
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy
What is the management for undescended testis
Newborns: watch and wait (likely to descend by 3-6 months)
If not descended by 6 months, orchidopexy (at 6-12 months)
What is hypospadias
Urethral meatus displaced to ventral side of penis (anywhere between further down glans to base of shaft)
Have an abnormal foreskin
Diagnosed during newborn examination
What is the management for hypospadias
Not to be circumcised until seen by a urologist
Mild: no treatment needed
Surgery: at 3-4 months (correct position of meatus, straighten penis)
What are the complications of hypospadias
Difficulty directing urine
Cosmetic and psychological concerns
Sexual dysfunction
What is a hydrocele
Collection of fluid in tunica vaginalis
Simple: common in newborns, trapped fluid gets reabsorbed over time
Communicating: tunica vaginalis connected to peritoneal cavity via processus vaginalis, size fluctuates over time
What are the investigations for hydrocele
Physical examination (soft, smooth, non-tender swelling, transilluminates)
What is the management for hydrocele
Simple: resolves by age 2
Communicating: surgery (remove or ligate processus vaginalis)
